Journal
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
Volume 99, Issue 4, Pages 1322-1329Publisher
ENDOCRINE SOC
DOI: 10.1210/jc.2013-4105
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Funding
- National Institutes of Health (NIH) [K23-DK094820]
- NIH/National Center for Research Resources [UL1 RR025758]
- NIH/National Center for Advancing Translational Science [UL1 TR000170-05]
- Jane Walentas Women's Health Award from the Foundation for Women's Wellness
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Context: Anorexia nervosa (AN), a prevalent psychiatric disorder predominantly affecting women, is characterized by self-induced starvation and low body weight. Increased clinical fractures are common, and most women have low bone mineral density (BMD). Previously investigated treatments have led to no or modest increases in BMD in AN. Objective: Our objective was to investigate the effect of teriparatide (TPT; human PTH[1-34]), an anabolic agent, on low bone mass in women with AN. Design, Setting, and Patients: This randomized, placebo-controlled trial at a clinical research center included 21 women with AN: 10 (mean age +/- SEM, 47 +/- 2.7 years) treated with TPT and 11 (47.1 +/- 2.3 years) treated with placebo. Interventions: TPT (20 mu g SC) or placebo was administered for 6 months. Main Outcome Measures: Our primary outcome measure was change in BMD of the spine and hip by dual-energy x-ray absorptiometry. Secondary outcome measures included changes inserum N-terminal propeptide of type 1 procollagen (P1NP), C-terminal collagen cross-links, sclerostin, and IGF-1 levels. Results: At 6 months, spine BMD increased significantly more with TPT (posteroanterior spine, 6.0% +/- 1.4%; lateral spine, 10.5% +/- 2.5%) compared with placebo (posteroanterior spine, 0.2% +/- 0.7%, P < .01; lateral spine, -0.6% +/- 1.0%; P < .01). The results remained significant after controlling for baseline body mass index, P1NP, and IGF-1. Changes in femoral neck (P = .4) and total hip (P = 0.8) BMD were comparable in both groups, as were changes in weight. Serum P1NP levels increased after 3 months of TPT treatment and remained at this higher level at 6 months, whereas P1NP levels were unchanged in the placebo group (P = .02). TPT was well-tolerated by all subjects. Conclusions: This study demonstrates that TPT administration increases spine BMD substantially after only 6 months of therapy in women with AN.
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